Best Antidepressant for Anhedonia

Primary Recommendation

Bupropion should be initiated as first-line therapy for patients with depression and prominent anhedonia, starting at 37.5 mg every morning and increasing by 37.5 mg every 3 days to a target of 150 mg twice daily 2
The American College of Physicians guidelines recommend bupropion as a first-line treatment option for anhedonia, due to its dopaminergic mechanism of action that directly addresses the reward processing deficits underlying anhedonia 1
Bupropion has the additional benefit of being activating, which can rapidly improve energy levels—a common complaint in anhedonic patients 2

Mirtazapine has a faster onset of action than SSRIs and may be particularly useful when anhedonia coexists with insomnia, poor appetite, or weight loss 3, 4

The American College of Physicians guidelines acknowledge that while second-generation antidepressants are equivalent for general depression, they do not address anhedonia specifically, and SSRIs should be avoided as first-line treatment for anhedonia 4, 5, 6

Assessment should begin within 1-2 weeks of treatment initiation to monitor response, as anhedonia may not improve at the same rate as other depressive symptoms 4, 7
If no adequate response occurs within 6-8 weeks, treatment modification is warranted rather than continuing an ineffective agent 4, 7